25, Help with QOL

32" waist
165-170 lbs
Live in USA

No Chest, upper stomach or back hair. Light arm and leg hair. Very little arm pit hair. Very light, almost non-existent hair around nipples. Hair around belly button leading down to pubic hair. Normal pubic hair. Light, patchy facial hair.

No alcohol or drug use.

I have very little muscle mass or definition.

I was fairly short my freshman year of high school, but grew fairly quickly beginning mid-to-late soph. year.

Lower ab fat. Most fat is carried lower back and butt. Some fat on quads. Very little upper pec fat, tricep or calf fat.

I was born with an undescended testicle. I had surgery to correct it when I was ~5 y.o. I have a mild case of gynecomastia. I was obese, 270 pounds, ~2 years ago. I lost the weight slowly with a non-retarded diet and exercise.

Diet is normal. Lots of veggies, some fruit, fish oil. Low-moderate carbs. 1-2g protein per pound.

Training is normal. Weight lifting 3 times per week. Low intensity cardio 3 times per week for 30-40 minutes. Sometimes I substitute yoga for a cardio day.

Several years ago I had a sore testicle for a couple of days. It went away quickly and I did not see a dr about it.

Morning wood occasionally. Not as stiff as it once was.

I am grumpy, very depressed and anxious a lot. I have zero confidence. I have trouble concentrating and have zero drive. I do not enjoy doing things I once did. I react to stressful situations, even small inconsequential things poorly. I am often short with people who don’t deserve it. I have trouble finding or remembering words from my vocabulary when trying to type an email or speak with someone. I have very little to no libido.

No antiobiotic treatments within the past 5 years.

No problems urinating. I do “leak” a bit when I am done peeing. This was not always the case and struck me as odd.

Multivitamin, vit. d, green tea extract, mag., zinc

sleep is normal. 7-9 hours of sleep per night. occasionally waking up to go to the bathroom.

I don’t think I’ve had any exposure to chemicals. I eat some seafood. 1-2 times per week. I use some salt, but I do not think it is iodized.

My nails are somewhat brittle. I have a full head of long hair, but I seem to lose a lot brushing or in the shower.

Other Symptoms:
-Brain fog, no one knows what that means but everyone knows if they have it!
-extreme Social withdrawal - “I would rather not go out”
-Why am I a moody bitch?
-Why do really stressful situations leave me feeling physically beat up. Adrenal fatigue.
-Dry skin, brittle hair and nails
-I just don’t care about anything, no joy, no motivation, no reward

Test Description Result Range Units
Estradiol 13.3 7.6-42.6 pg/mL
Estrogens, Total 99 40-115 pg/mL
LH 2.3 1.7-8.6 mIU/mL
FSH 1.8 1.5-12.4 mIU/mL
Vitamin D, 25-Hydroxy 51.8 32.0-100.0 ng/mL
Testosterone, Serum 480 249-836 ng/dL
TSH 3.43 0.450-4.500 uIU/mL
Estrone, Serum 11 12-72 pg/mL
DHEA-Sulfate 97.4 160.0-449.0 ug/dL
T3,Free,Serum 3.4 2.0-4.4 pg/mL
T4,Free(Direct) 1.82 0.82-1.77 ng/dL
% Free Testosterone 2.24 1.50-4.20 %
Testosterone,Free 10.75 5.00-21.00 ng/dL
BUN 25 6-20 mg/dL

Please edit your post so we can more easily read the garbled blood work.

Most of your levels look fine. TSH is a bit high despite your higher than range ft4. This indicates a degree of Reverse T3 pooling as your ft3 is not all that high, and your body is not utilizing the T3 that it does have.

This is most likely attributed to a cortisol imbalance, which you didn’t appear to test. Look into a 4x/day saliva coritsol test along with 8 am serum. Also check ferritin/iron. Iodine as well. Your issues probably lie with one of the above.

Do you “crash” at certain points of the daY? Have trouble waking up/falling asleep?

Sorry about the editing. I don’t notice any kind of crash during the day. I don’t have any sleep problems that I’m aware of.

Looking back through, two things stick out:

-DHEA is low…this may have driven the pituitary to downregulate LH/FSH to compensate, or maybe vice versa…would be worth supplementing to see if pituitary output increases, along with T…if that doesn’t work, a clomid challenge/restart may be a good option

-Total Estrogens are high, but E1 & E2 are low (24 total). E3 = 99 - 24 = 75. Not sure the significance of this as we don’t see many (any?) E3 issues, but that is interesting and should warrant further investigation.

Since you don’t have crashes or sleep issues, cortisol may be ok. Would be best to verify, but ferritin/iron probably tells a better story.

Also, are you taking a Vit D supplement? This could be higher…I aim for the 80’s…6k iu/day of a highly bioavailable liquid brand keeps me there.

Yes, I do take a vit. d supplement. I get 1k iu from multi-vitamin(source naturals life force) and 2k iu from carlson d3. I also get 30-60 min of sun a day.

I’m having trouble figuring out how your DHEA-S can be well out of range low, but your test is at least moderately close to halfway decent.

I’d also bet a good chunk of change your RT3 is sky-high… that explains your high TSH in the presence of plenty of thyroid hormone, as well as your out-of-range ft4 that is to the right of ft3 on the relative scale. Test cortisol and get some proper cortisol support to help this. If cortisol is fine you may need slow release t3-only thyroid meds.

Not sure what else could be messing up your conversion. Anything from hashimotos to poor iron levels, to prolonged low-carb dieting can mess with this. The latter point may be a concern - I’m guessing that’s one way you might’ve lost so much weight.

I would test reverse t3, ferritin, TPO/ATA (thyroid antibody tests for hashi’s), DHT (libido), and cortisol. Maybe throw in pregnenolone and progesterone with cholesterol to see the whole chain. If you want to do everything at once and have good insurance, a full iron lab workup could help too.

I have Dr.'s appts. Weds. and Thurs. Any other questions I should ask or tests I should request? Dr. compliance and/or insurance shouldn’t present any problems.

Here is my cbc with iron serum:

Calcium, Serum 10.5 8.7-10.2 mg/dL
Phosphorus, Serum 4.1 2.5-4.5 mg/dL
Glucose, Serum 86 65-99 mg/dL
BUN 25 6-20 mg/dL
Creatinine, Serum 1.05 0.76-1.27 mg/dL
Cholesterol, Total 163 100-199 mg/dL
Protein, Total, Serum 7.3 6.0-8.5 g/dL
Albumin, Serum 5.2 3.5-5.5 g/dL
Bilirubin, Total 0.5 0.0-1.2 mg/dL
Potassium, Serum 4.5 3.5-5.2 mmol/L
Sodium, Serum 143 135-145 mmol/L
Chloride, Serum 104 97-108 mmol/L
Iron, Serum 85 40-155 ug/dL
Hemoglobin 15.3 12.5-17.0 g/dL
Hematocrit 44.5 36.0-50.0 %

Dr. ordered 4x cortisol, dht, ferritin, reverse t3, pregnenolone, progesterone and some other things. She talked about adding in T, DHEA and possibly hcg for the lowish lh/fsh levels which could be caused by a wonky testicle with an ai if needed. Any comments or things to add?

I’m happy I found a doctor who appears to be knowledge, able to listen and seemlingly aggressive. I’m a bit apprehensive as I realize I am over my skis with all of this. I told her to give me a day or two to think things over so I could do some more proper research. Any insight would be greatly appreciated.

I think going on TRT at this point is a mistake…at your age, there are other options that I would explore before committing to sticking myself 2-3x/week for the next 75 years…your problem may be as easily correctable as DHEA supplementation, or maybe DHEA + SERM Challenge/Restart…

That was my feeling, too. We are going to wait until after gyno surgery to discuss that further. I forgot to mention pregnenolone and progesterone were also ordered. I edited my previous post to add those in.

I was given life extension dhea complete pills and dhea plus topical cream.

Should have next round of saliva, blood, urine tests soon. Thank you very much for sharing your knowledge.

Where are you located in the US?

South Florida

Couple of more tests back. Retested thyroid and test. today. Hope to have those back early next week.

Iron 22 L 40-190 ug/dl
Total Iron-bind, Capacity 244 L 250-400 ug/dl
% Iron Saturation 9 L 15-50 %

Progesterone .23 0.2-1.4 ng/ml

Pregnenolone 262 38-350 ng/dl

Reverse T3 437 H 90-350 pg/ml

4x cortisol was normal

Forgot to add that TPO/ATA tests came back ok.

More test results back in. Dr. ordered Iodine blood test. Should have results in a day or 2.

t3, free 4.7h 1.8 - 4.6 pg/ml
TSH 1.930 0.27 - 4.2 uIU/ml

Estradiol 19.3 7.6 - 42.6 pg/ml

Test., total 334 280 - 1100 ng/dl
SHBG 53 10 - 80
Test., free 4.41 1.9 - 27 ng/dl

4x cortisol

wake .56 .27 - 1.18 mcg/dl
11-1 .22 .10 - .41
3-5 .14 .05 - .27
10-12 .05 .03 - .14

Dr. recommended DHEA-s and Iron supplementation and prescribed Testosterone cyprionate injections and Anastrozole. Not really sure what to do or where to go from here. Any input before I make any decisions would be really appreciated.

… great spot on advice from the board to date… but what your doctor is suggesting right now is really really really aggressive.

your cortisol is not great. it should be in the upper 75%-100% percentile of the range (normally)

yes, Testosterone is low, but you should fix your ungodly RT3 issue first which could be caused in part by your low iron results. please read thyroid-rt3.com and stopthethyroidmadness before you go any further.

slow down, tackle one thing at a time.

There are many people who jump into treatment to quick just look at all of the threads. I was thrown into treatment way too soon and have spent years trying to balance things out with little to show for it - so believe me, I have been there and done that.

the biggest red flags are your RT3 and low iron. spend some time (i.e. 2-3 months) fixing those. then retest and see what your symptoms tell you.

Iodine, serum 180 h 52 - 109 mcg/L